ORIGINAL ARTICLE
Patient Satisfaction Surveys: An Evaluation of POSNA Members’ Knowledge and Experience Matthew F. Halsey, MD,* Stephen A. Albanese, MD,w Mihir Thacker, MD,z and Project of the POSNA Practice Management Committee
Background: Patient satisfaction surveys (PSS) were originally designed to identify areas in need of improvement in patient interactions for individuals, practices, and institutions. As a result of the Affordable Care Act, the Centers for Medicare and Medicaid Services incorporated PSS into a formula designed to determine the quality of medical care delivered to hospital inpatients; the resultant score and rank will determine subsequent hospital payments. This survey was developed to evaluate POSNA members’ knowledge of and experience with PSS. Methods: The POSNA Practice Management Committee developed a 14-question survey that was sent to all active and candidate members (850). A total of 229 members responded; and results were tabulated by answer and simple percentages were calculated for each question. Comments were reviewed and grouped by similarity to identify frequency. Results: A total of 82% of respondents were aware of PSS with 67% stating they were utilized in their setting. Utilization of PSS rarely alters clinical decision making. However, PSS do affect decisions regarding the patient experience; and 45% of respondents believe that PSS have utility with respect to business decisions. Fifty-nine percent of respondents feel that scores can be predictably improved. Less than half the respondents stated that they had a good or excellent understanding of PSS and only 48% believe that PSS are a valid measure of health care quality. Conclusions: POSNA members’ knowledge of and experience with PSS are not universal or uniform. Although most agree that patient satisfaction does not drive clinical decision making, it does appear to impact business and clinic-flow decisions with the idea that it can be predictably improved. Despite this, members’ self-assessed that knowledge is average and it is not clear to the members that patient satisfaction reflects medical quality. On the basis of these findings and as the impacts of PSS become more prominent, efforts to educate the members of POSNA about PSS should be enhanced. Furthermore, research to identify and develop best practices that enhance patient sat-
From the *Department of Orthopedic Surgery and Rehabilitation, Oregon Health & Science University, Portland, OR; wSUNY Upstate Medical University, Syracuse, NY; and zAlfred I. DuPont Hospital for Children, Wilmington, DE. The authors declare no conflicts of interest. Reprints: Matthew F. Halsey, MD, Department of Orthopedic Surgery and Rehabilitation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP-31, Portland, OR 97239. E-mail: halseyma@ ohsu.edu. Copyright r 2014 by Lippincott Williams & Wilkins
104 | www.pedorthopaedics.com
isfaction and well-being while minimizing costs should be supported. Level of Evidence: Level IV. Key Words: patient satisfaction surveys, POSNA Practice Management Committee Survey, knowledge, decision making, health care quality (J Pediatr Orthop 2015;35:104–107)
P
atient satisfaction surveys (PSS) have been in existence for decades. They were originally designed to assess specific and general aspects of a patient’s experience in an office or hospital setting in response for a desire to improve the service orientation of medical care delivery. As such, they were utilized by physician practices and hospitals to identify potential deficiencies and areas for improvement beyond the purely medical and surgical outcomes usually measured. Over time these surveys have been increasingly conducted by national organizations allowing for comparison with similar practices and institutions. Despite the growth of PSS utilization, it is not clear what impacts patient satisfaction and/or the impact that patient satisfaction has on medical and surgical outcomes.1 Until recently, how a practice or institution scored did not directly impact compensation by Medicare or other third-party payers; however, that has changed with the passage of the Affordable Care Act (ACA) in 2010. Beginning in 2012, the Centers for Medicare & Medicaid Services surveyed patients from >3000 hospitals using a standardized PSS, the Hospital Consumer Assessment of Healthcare Providers and Systems survey. This PSS, along with other quality measures, will be used to decrease hospital Medicare reimbursements by 1% for those institutions scoring poorly and to increase reimbursements by the same amount for those scoring well. This adjustment will rise to 2% in 2014. Extension of these types of adjustments to other third-party payers like Medicaid and commercial insurance companies is certainly a future possibility. The purpose of this study was to evaluate the POSNA membership’s knowledge of and experience with PSS. By highlighting this issue, the POSNA Practice Management Committee hopes to promote and protect J Pediatr Orthop
Volume 35, Number 1, January 2015
J Pediatr Orthop
Volume 35, Number 1, January 2015
patient health and safety; to promulgate pertinent ideas and experiences with respect to PSS as well as to enhance personal career satisfaction.
METHODS The POSNA Practice Management Committee developed a 14-question survey and introduction for their membership. The survey questions were designed to assess the awareness and prevalence of PSS; to identify clinical impacts; to evaluate the use and utility of PSS outcomes; to assess whether PSS scores affect compensation; and to elucidate potential methods of improving PSS scores. The survey was sent to all active and candidate POSNA members (850) through email and was accessed using a web link using a standardized survey tool, Survey Monkey (http://www.surveymonkey.com). A total of 229 members (B27%) responded to the survey. The results were tabulated by the potential answers and simple percentages for each question were calculated. Two questions asked for comments (#12 and #13). The comments were reviewed and grouped by similarity to identify frequency.
Patient Satisfaction Surveys
and/or how much time is spent with each patient. Fortyeight (28%) respondents stated that they have altered these parameters in response to PSS. Furthermore, 45% (79/229) of respondents stated that PSS do have utility with respect to business and budgeting decisions in the office. Fifth-nine percent (135/229) of respondents stated that scores can be improved, whereas 19% disagreed and 22% were not sure. When queried about methods to successfully improve PSS scores, the most common responses were decreased clinic wait times, improved patient flow and scheduling, improved access to appointments, increased amount of time spent with patient, and improved communication and educational materials. Finally, respondents were questioned regarding their level of understanding of PSS and whether they considered PSS a valid quality metric. The level of understanding (self-assessed) was quite varied. More than half felt that they had only a poor (15%) or fair (39%) understanding of PSS versus those who felt they had a good (32%) or excellent (14%) understanding of PSS. Only 21% of the respondents felt that PSS was a valid measure of health care quality; whereas, 48%, nearly half felt it was not and 31% were uncertain about its value.
RESULTS A total of 229 POSNA members responded to the survey over a 3-week period spanning December 2012 through January 2013. Eighty-two percent (188/229) responded that they were aware of PSS, whereas 18% responded that they were unaware or not sure of their existence. Of those aware of PSS, 67% (154/229) responded that they are used at their institutions; 19% (44/ 229) said that they were not utilized; and 14% (31/229) were not sure if they were used or not. PSS data were shared with respondents in quite a varied manner. PSS reports were received by respondents most commonly on a monthly (25%) or quarterly (34%) basis, whereas others receive the reports semiannually (8%) or annually (6%). The number of surveys included in each report was also quite varied. In those institutions or practices where the PSS were utilized, 36% (62/229) responded that they were given some kind of personal feedback by the hospital; conversely, 64% (109/229) did not receive regular feedback on the scores. Feedback, when given, usually consisted of a discussion or review of the results with practice managers or administrators. However, some members responded that classes or coaches were offered as methods to improve PSS. Utilization of PSS does not appear to have a major impact on clinical practice or decision making. Only 6% of respondents answered affirmatively that PSS affect tests that are offered and merely 3% of respondents agreed that the PSS affect the decision to offer elective surgery. Similarly, just 14% of respondents believed that PSS predicted improved clinical outcomes, whereas 64% disagreed and 22% were not sure that PSS predicted improved clinical outcomes. There is a more pronounced effect on decisions regarding the number of patients seen during office hours r
2014 Lippincott Williams & Wilkins
DISCUSSION The Institute of Medicine, in their monogram “Crossing the quality chasm,”2 identified and defined several characteristics of the medical field including structures, processes, efficiency measures, and outcomes that are both actionable and clinically relevant. The main purpose behind these characterizations was 2-fold: to make the medical field more patient-centric; and, to replace the current concept of compensation based on quantity of work with one rewarding quality of work.3 Patient satisfaction, as measured by survey, is not unreasonably one of the highlighted characteristics that will be measured and used to assess medical quality. The purpose of this study was to evaluate the experience, heretofore, of the POSNA membership with PSS along with its various aspects and impacts. Although PSS are an integral part of the ACA, nearly one fifth of the respondents did not know of their existence. As our survey did not require the respondent to provide background information, we were unable to determine if there is a particular segment of the POSNA membership who is more likely to be unaware of PSS. Likewise, a third of the respondents stated that their institution was not utilizing PSS. Undoubtedly, despite the universal impact of changes promulgated by the ACA, the experience with PSS among members of POSNA is not ubiquitous. Recent editorials in the Journal of Bone & Joint Surgery and the AAOS Now publication may have increased surgeon awareness of PSS; however, given the potential impact on hospital and physician compensation, it is surprising that awareness of PSS is not more universal.4,5 Furthermore, of those POSNA members who had experience with PSS, only half of the respondents felt they had a good or excellent understanding of this tool. In www.pedorthopaedics.com |
105
Halsey et al
addition, only one third received any regular training or feedback which mainly consisted of discussion and review. This lack of understanding may reflect several issues including a lack of education or training with respect to PSS, as well as, the mistaken notion that physicians already communicate more than adequately with their patients and that their patients are satisfied enough.6 For POSNA members, PSS do impact the practice of pediatric orthopaedics more so in the design of the practice environment rather than in clinical decision making. Less than one tenth of the respondents stated that PSS had any impact on the decision to order tests or to offer elective surgeries. In contrast, nearly half of the respondents stated that PSS do impact business and budget decisions, whereas little more than a quarter of the respondents said that it had an impact on clinic numbers or time spent with the patient. Respondents were queried as to the ability to predictably improve PSS and >60% answered affirmatively. Further questioning identified a number of aspects of the patient experience that have the greatest impact on improving scores including: decreased clinic wait time; improved scheduling and patient flow; improved access to the appointments; increased time spent with the patient; improved front-office experience; and improved communication. Other less common suggestions ranged from improving the parking situation to strengthening privacy measures to even “coaching” a good score from the family and patient. These suggestions by POSNA members are corroborated by the findings of several researchers who have identified factors that can positively influence PSS including: decreased perception of wait time; decreased appointment duration; and the office environment and expectation management. Camacho et al7 found that excessive wait times decreased patient satisfaction and this effect was more pronounced if the visit time was 50,000 Medical Expenditure Panel Surveys and found that higher patient satisfaction, while correlated with fewer emergency department visits, was associated with increased inpatient utilization, prescription drug expenditures, higher health care costs, and increased mortality. Surgeon assessment of prospectively performed PSS, such as Press Ganey, may reflect the perception that the sampling is potentially biased (< 5% return surveys). It is difficult or impossible to predictably and sustainably improve survey results with practice changes; and, not all aspects of the clinic or hospital environment are under the control of the surgeon. Furthermore, when the Press Ganey results are analyzed, it appears that score
TABLE 1. Mnemonic for the Elements of a Successful Visit ICARE
Introduce yourself Communicate the plan Ask and anticipate needs Respond to patient/family questions Exit courteously Acknowledge Introduce Duration Explanation Thank you
AIDET
r
2014 Lippincott Williams & Wilkins
J Pediatr Orthop
Volume 35, Number 1, January 2015
distributions demonstrate very high kurtosis around a high mean so that a slight (< 1%) score change leads to a dramatic change in percentile score (>10%). Despite the lack of valid clinical data that supports the premise that PSS-driven changes correlate with improved clinical outcomes or even resource management, PSS have become a critical element in how physicians and surgeons are evaluated, rated, and perhaps compensated. Further research is required to identify and develop those best practices that not only improve the subjective patient experience, but maximize patient health and well-being while minimizing resource utilization. REFERENCES 1. Fenton JJ, Jerant AF, Bertakis KD, et al. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med. 2012;172:405–411. 2. Institute of Medicine. Crossing the Quality Chasm: a New health System for the Twenty-First Century. Washington, DC: National Academies Press; 2001. 3. Farley FA, Weinstein SL. The case for patient-centered care in orthopaedics. J Am Acad Orthop Surg. 2006;14:447–451. 4. Shirley ED, Sanders JO. Patient satisfaction: implications and predictors of success. J Bone Joint Surg Am. 2013;95:e69, 1-4. 5. Morris BJ, Jahangir AA, Sethi MK. Patient satisfaction: an emerging health policy issue. What the orthopaedic surgeon needs to know. AAOS Now [serial online]. 2013;7 http://www.aaos.org/news/aaosnow/ jun13/advocacy5.asp Accessed August 22, 2013. 6. Olson DP, Windish DM. Communication discrepancies between physicians and hospitalized patients. Arch Intern Med. 2010; 170:1302–1307.
r
2014 Lippincott Williams & Wilkins
Patient Satisfaction Surveys
7. Camacho F, Anderson R, Safrit A, et al. The relationship between patient’s perceived waiting time and office-based practice satisfaction. N C Med J. 2006;67:409–413. 8. Becker F, Douglass S. The ecology of the patient visit: physical attractiveness, waiting times, and perceived quality of care. J Ambul Care Manage. 2008;31:128–141. 9. Levesque J, Bogoch ER, Cooney B, et al. Improving patient satisfaction with time spent in an orthopedic outpatient clinic. Can J Surg. 2000;43:431–436. 10. Williams G, Pattison G, Mariathas C, et al. Improving parental satisfaction in pediatric orthopaedics. J Pediatr Orthop. 2011;31: 610–615. 11. Mayich DJ, Tieszer C, Lawendy A, et al. Role of patient information handouts following operative treatment of ankle fractures: a prospective randomized study. Foot Ankle Int. 2013;34: 2–7. 12. Anderson R, Barbara A, Feldman S. What patients want: a content analysis of key qualities that influence patient satisfaction. J Med Pract Manage. 2007;22:255–261. 13. Prakash B. Patient satisfaction. J Cutan Aesthet Surg. 2010;3: 151–155. 14. Brown JB, Boles M, Mullooly JP, et al. Effect of clinician communication skills training on patient satisfaction. A randomized, controlled trial. Ann Intern Med. 1999;131:822–829. 15. Shilling V, Jenkins V, Fallowfield L. Factors affecting patient and clinician satisfaction with the clinical consultation: can communication skills training for clinicians improve satisfaction? Psychooncology. 2003;12:599–611. 16. Bre´dart A, Bottomley A. Treatment satisfaction as an outcome measure in cancer clinical treatment trials. Expert Rev Pharmacoecon Outcomes Res. 2002;2:597–606. 17. Kirsner RS, Federman DG. Patient satisfaction: quality of care from the patients’ perspective. Arch Dermatol. 1997;133:1427–1431.
www.pedorthopaedics.com |
107
Patient Satisfaction Surveys: An Evaluation of POSNA Members’ Knowledge and Experience Matthew F. Halsey, MD,* Stephen A. Albanese, MD,w Mihir Thacker, MD,z and Project of the POSNA Practice Management Committee
Background: Patient satisfaction surveys (PSS) were originally designed to identify areas in need of improvement in patient interactions for individuals, practices, and institutions. As a result of the Affordable Care Act, the Centers for Medicare and Medicaid Services incorporated PSS into a formula designed to determine the quality of medical care delivered to hospital inpatients; the resultant score and rank will determine subsequent hospital payments. This survey was developed to evaluate POSNA members’ knowledge of and experience with PSS. Methods: The POSNA Practice Management Committee developed a 14-question survey that was sent to all active and candidate members (850). A total of 229 members responded; and results were tabulated by answer and simple percentages were calculated for each question. Comments were reviewed and grouped by similarity to identify frequency. Results: A total of 82% of respondents were aware of PSS with 67% stating they were utilized in their setting. Utilization of PSS rarely alters clinical decision making. However, PSS do affect decisions regarding the patient experience; and 45% of respondents believe that PSS have utility with respect to business decisions. Fifty-nine percent of respondents feel that scores can be predictably improved. Less than half the respondents stated that they had a good or excellent understanding of PSS and only 48% believe that PSS are a valid measure of health care quality. Conclusions: POSNA members’ knowledge of and experience with PSS are not universal or uniform. Although most agree that patient satisfaction does not drive clinical decision making, it does appear to impact business and clinic-flow decisions with the idea that it can be predictably improved. Despite this, members’ self-assessed that knowledge is average and it is not clear to the members that patient satisfaction reflects medical quality. On the basis of these findings and as the impacts of PSS become more prominent, efforts to educate the members of POSNA about PSS should be enhanced. Furthermore, research to identify and develop best practices that enhance patient sat-
From the *Department of Orthopedic Surgery and Rehabilitation, Oregon Health & Science University, Portland, OR; wSUNY Upstate Medical University, Syracuse, NY; and zAlfred I. DuPont Hospital for Children, Wilmington, DE. The authors declare no conflicts of interest. Reprints: Matthew F. Halsey, MD, Department of Orthopedic Surgery and Rehabilitation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP-31, Portland, OR 97239. E-mail: halseyma@ ohsu.edu. Copyright r 2014 by Lippincott Williams & Wilkins
104 | www.pedorthopaedics.com
isfaction and well-being while minimizing costs should be supported. Level of Evidence: Level IV. Key Words: patient satisfaction surveys, POSNA Practice Management Committee Survey, knowledge, decision making, health care quality (J Pediatr Orthop 2015;35:104–107)
P
atient satisfaction surveys (PSS) have been in existence for decades. They were originally designed to assess specific and general aspects of a patient’s experience in an office or hospital setting in response for a desire to improve the service orientation of medical care delivery. As such, they were utilized by physician practices and hospitals to identify potential deficiencies and areas for improvement beyond the purely medical and surgical outcomes usually measured. Over time these surveys have been increasingly conducted by national organizations allowing for comparison with similar practices and institutions. Despite the growth of PSS utilization, it is not clear what impacts patient satisfaction and/or the impact that patient satisfaction has on medical and surgical outcomes.1 Until recently, how a practice or institution scored did not directly impact compensation by Medicare or other third-party payers; however, that has changed with the passage of the Affordable Care Act (ACA) in 2010. Beginning in 2012, the Centers for Medicare & Medicaid Services surveyed patients from >3000 hospitals using a standardized PSS, the Hospital Consumer Assessment of Healthcare Providers and Systems survey. This PSS, along with other quality measures, will be used to decrease hospital Medicare reimbursements by 1% for those institutions scoring poorly and to increase reimbursements by the same amount for those scoring well. This adjustment will rise to 2% in 2014. Extension of these types of adjustments to other third-party payers like Medicaid and commercial insurance companies is certainly a future possibility. The purpose of this study was to evaluate the POSNA membership’s knowledge of and experience with PSS. By highlighting this issue, the POSNA Practice Management Committee hopes to promote and protect J Pediatr Orthop
Volume 35, Number 1, January 2015
J Pediatr Orthop
Volume 35, Number 1, January 2015
patient health and safety; to promulgate pertinent ideas and experiences with respect to PSS as well as to enhance personal career satisfaction.
METHODS The POSNA Practice Management Committee developed a 14-question survey and introduction for their membership. The survey questions were designed to assess the awareness and prevalence of PSS; to identify clinical impacts; to evaluate the use and utility of PSS outcomes; to assess whether PSS scores affect compensation; and to elucidate potential methods of improving PSS scores. The survey was sent to all active and candidate POSNA members (850) through email and was accessed using a web link using a standardized survey tool, Survey Monkey (http://www.surveymonkey.com). A total of 229 members (B27%) responded to the survey. The results were tabulated by the potential answers and simple percentages for each question were calculated. Two questions asked for comments (#12 and #13). The comments were reviewed and grouped by similarity to identify frequency.
Patient Satisfaction Surveys
and/or how much time is spent with each patient. Fortyeight (28%) respondents stated that they have altered these parameters in response to PSS. Furthermore, 45% (79/229) of respondents stated that PSS do have utility with respect to business and budgeting decisions in the office. Fifth-nine percent (135/229) of respondents stated that scores can be improved, whereas 19% disagreed and 22% were not sure. When queried about methods to successfully improve PSS scores, the most common responses were decreased clinic wait times, improved patient flow and scheduling, improved access to appointments, increased amount of time spent with patient, and improved communication and educational materials. Finally, respondents were questioned regarding their level of understanding of PSS and whether they considered PSS a valid quality metric. The level of understanding (self-assessed) was quite varied. More than half felt that they had only a poor (15%) or fair (39%) understanding of PSS versus those who felt they had a good (32%) or excellent (14%) understanding of PSS. Only 21% of the respondents felt that PSS was a valid measure of health care quality; whereas, 48%, nearly half felt it was not and 31% were uncertain about its value.
RESULTS A total of 229 POSNA members responded to the survey over a 3-week period spanning December 2012 through January 2013. Eighty-two percent (188/229) responded that they were aware of PSS, whereas 18% responded that they were unaware or not sure of their existence. Of those aware of PSS, 67% (154/229) responded that they are used at their institutions; 19% (44/ 229) said that they were not utilized; and 14% (31/229) were not sure if they were used or not. PSS data were shared with respondents in quite a varied manner. PSS reports were received by respondents most commonly on a monthly (25%) or quarterly (34%) basis, whereas others receive the reports semiannually (8%) or annually (6%). The number of surveys included in each report was also quite varied. In those institutions or practices where the PSS were utilized, 36% (62/229) responded that they were given some kind of personal feedback by the hospital; conversely, 64% (109/229) did not receive regular feedback on the scores. Feedback, when given, usually consisted of a discussion or review of the results with practice managers or administrators. However, some members responded that classes or coaches were offered as methods to improve PSS. Utilization of PSS does not appear to have a major impact on clinical practice or decision making. Only 6% of respondents answered affirmatively that PSS affect tests that are offered and merely 3% of respondents agreed that the PSS affect the decision to offer elective surgery. Similarly, just 14% of respondents believed that PSS predicted improved clinical outcomes, whereas 64% disagreed and 22% were not sure that PSS predicted improved clinical outcomes. There is a more pronounced effect on decisions regarding the number of patients seen during office hours r
2014 Lippincott Williams & Wilkins
DISCUSSION The Institute of Medicine, in their monogram “Crossing the quality chasm,”2 identified and defined several characteristics of the medical field including structures, processes, efficiency measures, and outcomes that are both actionable and clinically relevant. The main purpose behind these characterizations was 2-fold: to make the medical field more patient-centric; and, to replace the current concept of compensation based on quantity of work with one rewarding quality of work.3 Patient satisfaction, as measured by survey, is not unreasonably one of the highlighted characteristics that will be measured and used to assess medical quality. The purpose of this study was to evaluate the experience, heretofore, of the POSNA membership with PSS along with its various aspects and impacts. Although PSS are an integral part of the ACA, nearly one fifth of the respondents did not know of their existence. As our survey did not require the respondent to provide background information, we were unable to determine if there is a particular segment of the POSNA membership who is more likely to be unaware of PSS. Likewise, a third of the respondents stated that their institution was not utilizing PSS. Undoubtedly, despite the universal impact of changes promulgated by the ACA, the experience with PSS among members of POSNA is not ubiquitous. Recent editorials in the Journal of Bone & Joint Surgery and the AAOS Now publication may have increased surgeon awareness of PSS; however, given the potential impact on hospital and physician compensation, it is surprising that awareness of PSS is not more universal.4,5 Furthermore, of those POSNA members who had experience with PSS, only half of the respondents felt they had a good or excellent understanding of this tool. In www.pedorthopaedics.com |
105
Halsey et al
addition, only one third received any regular training or feedback which mainly consisted of discussion and review. This lack of understanding may reflect several issues including a lack of education or training with respect to PSS, as well as, the mistaken notion that physicians already communicate more than adequately with their patients and that their patients are satisfied enough.6 For POSNA members, PSS do impact the practice of pediatric orthopaedics more so in the design of the practice environment rather than in clinical decision making. Less than one tenth of the respondents stated that PSS had any impact on the decision to order tests or to offer elective surgeries. In contrast, nearly half of the respondents stated that PSS do impact business and budget decisions, whereas little more than a quarter of the respondents said that it had an impact on clinic numbers or time spent with the patient. Respondents were queried as to the ability to predictably improve PSS and >60% answered affirmatively. Further questioning identified a number of aspects of the patient experience that have the greatest impact on improving scores including: decreased clinic wait time; improved scheduling and patient flow; improved access to the appointments; increased time spent with the patient; improved front-office experience; and improved communication. Other less common suggestions ranged from improving the parking situation to strengthening privacy measures to even “coaching” a good score from the family and patient. These suggestions by POSNA members are corroborated by the findings of several researchers who have identified factors that can positively influence PSS including: decreased perception of wait time; decreased appointment duration; and the office environment and expectation management. Camacho et al7 found that excessive wait times decreased patient satisfaction and this effect was more pronounced if the visit time was 50,000 Medical Expenditure Panel Surveys and found that higher patient satisfaction, while correlated with fewer emergency department visits, was associated with increased inpatient utilization, prescription drug expenditures, higher health care costs, and increased mortality. Surgeon assessment of prospectively performed PSS, such as Press Ganey, may reflect the perception that the sampling is potentially biased (< 5% return surveys). It is difficult or impossible to predictably and sustainably improve survey results with practice changes; and, not all aspects of the clinic or hospital environment are under the control of the surgeon. Furthermore, when the Press Ganey results are analyzed, it appears that score
TABLE 1. Mnemonic for the Elements of a Successful Visit ICARE
Introduce yourself Communicate the plan Ask and anticipate needs Respond to patient/family questions Exit courteously Acknowledge Introduce Duration Explanation Thank you
AIDET
r
2014 Lippincott Williams & Wilkins
J Pediatr Orthop
Volume 35, Number 1, January 2015
distributions demonstrate very high kurtosis around a high mean so that a slight (< 1%) score change leads to a dramatic change in percentile score (>10%). Despite the lack of valid clinical data that supports the premise that PSS-driven changes correlate with improved clinical outcomes or even resource management, PSS have become a critical element in how physicians and surgeons are evaluated, rated, and perhaps compensated. Further research is required to identify and develop those best practices that not only improve the subjective patient experience, but maximize patient health and well-being while minimizing resource utilization. REFERENCES 1. Fenton JJ, Jerant AF, Bertakis KD, et al. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med. 2012;172:405–411. 2. Institute of Medicine. Crossing the Quality Chasm: a New health System for the Twenty-First Century. Washington, DC: National Academies Press; 2001. 3. Farley FA, Weinstein SL. The case for patient-centered care in orthopaedics. J Am Acad Orthop Surg. 2006;14:447–451. 4. Shirley ED, Sanders JO. Patient satisfaction: implications and predictors of success. J Bone Joint Surg Am. 2013;95:e69, 1-4. 5. Morris BJ, Jahangir AA, Sethi MK. Patient satisfaction: an emerging health policy issue. What the orthopaedic surgeon needs to know. AAOS Now [serial online]. 2013;7 http://www.aaos.org/news/aaosnow/ jun13/advocacy5.asp Accessed August 22, 2013. 6. Olson DP, Windish DM. Communication discrepancies between physicians and hospitalized patients. Arch Intern Med. 2010; 170:1302–1307.
r
2014 Lippincott Williams & Wilkins
Patient Satisfaction Surveys
7. Camacho F, Anderson R, Safrit A, et al. The relationship between patient’s perceived waiting time and office-based practice satisfaction. N C Med J. 2006;67:409–413. 8. Becker F, Douglass S. The ecology of the patient visit: physical attractiveness, waiting times, and perceived quality of care. J Ambul Care Manage. 2008;31:128–141. 9. Levesque J, Bogoch ER, Cooney B, et al. Improving patient satisfaction with time spent in an orthopedic outpatient clinic. Can J Surg. 2000;43:431–436. 10. Williams G, Pattison G, Mariathas C, et al. Improving parental satisfaction in pediatric orthopaedics. J Pediatr Orthop. 2011;31: 610–615. 11. Mayich DJ, Tieszer C, Lawendy A, et al. Role of patient information handouts following operative treatment of ankle fractures: a prospective randomized study. Foot Ankle Int. 2013;34: 2–7. 12. Anderson R, Barbara A, Feldman S. What patients want: a content analysis of key qualities that influence patient satisfaction. J Med Pract Manage. 2007;22:255–261. 13. Prakash B. Patient satisfaction. J Cutan Aesthet Surg. 2010;3: 151–155. 14. Brown JB, Boles M, Mullooly JP, et al. Effect of clinician communication skills training on patient satisfaction. A randomized, controlled trial. Ann Intern Med. 1999;131:822–829. 15. Shilling V, Jenkins V, Fallowfield L. Factors affecting patient and clinician satisfaction with the clinical consultation: can communication skills training for clinicians improve satisfaction? Psychooncology. 2003;12:599–611. 16. Bre´dart A, Bottomley A. Treatment satisfaction as an outcome measure in cancer clinical treatment trials. Expert Rev Pharmacoecon Outcomes Res. 2002;2:597–606. 17. Kirsner RS, Federman DG. Patient satisfaction: quality of care from the patients’ perspective. Arch Dermatol. 1997;133:1427–1431.
www.pedorthopaedics.com |
107
