A Better Way to Elicit Patient Feedback

National Park Medical Center in Arkansas finds that an automated patient callback system gathers emergency department patient satisfaction data more effectively than paper surveys.

The other day as I was checking out at a local department store, the cashier drew a circle on my receipt and asked me to participate in a customer satisfaction survey. There'd be a discount emailed to me after I completed it, she said.

I smiled and shook my head yes, but I had no intention of filling it out.

This morning, the place where I buy my morning cup of coffee asked me to complete a survey.

For my participation, I'd be rewarded with doughnuts. I didn't take that one either.

And, recently, my children's daycare provider asked all the families to take part in a survey about the caregivers and facility. That one I actually did fill out since my children are more important to me than free doughnuts.

As we go about our day-to-day activities, Americans are bombarded by these types of surveys. Throw in healthcare surveys to measure patient satisfaction and experience, and I think we may be reaching the limit on the number of surveys we're willing to complete.

We're experiencing survey fatigue, and it has the potential to affect the data hospitals seek to collect.

Survey Fatigue
As healthcare professionals, we've (sadly) become familiar with the concept of alarm fatigue—that feeling of sensory overload that can desensitize us to the point of delaying our responses, or in the worst cases, not responding at all.

Survey fatigue is similar, except that instead of being overwhelmed by information coming at us, we're being overwhelmed by the frequency and amount of information we're being asked to provide.

Often, doughnuts and discounts aren't enough to compensate for the time and effort it takes to complete surveys. I admit there are a few patient satisfaction surveys in various stages of completion that have been floating around my house since September 2014 when I had my son. It's just one more task I just can't seem to find a chance, or the will, to do.

Much like dealing with the constant bombardment of bedside alarms, the easiest way to deal with the constant bombardment of surveys is to tune them out.

If You Can't Say Something Nice, Say it Anyway
It's easy to ignore surveys when there doesn't seem to be much benefit in it for the respondent. But to healthcare providers, this data is like gold. As reimbursement becomes tied to variables such as patient satisfaction, hospitals and healthcare systems will need to collect more high-quality data in order to get paid.

How do you do that when patients like me leave half-finished surveys sitting around for months and when they decide to take action, the action is to put them in the shredder?

National Park Medical Center in Hot Springs, AR, is trying one possible solution. Hoping to improve its collection of ED patient experience and satisfaction data, it began using with an automated patient call back system in February.

"We wanted an avenue where patients could basically discuss their ED visit at their convenience," says Priscilla Couch, RN, MSN, assistant chief nursing officer at NPMC. "We felt that having this, where they could do that at their convenience, would give us more feedback than what we were getting."
Couch explains that managers used to make follow-up phone calls to patients discharged from the ED between the hours of 8am and 5pm.

"Our callback rate wasn't as high as we'd like it to [have been]," she says. "The feedback was very, very positive which was not always indicative of our scores."

The discrepancy between what patients were telling managers over the phone and what they were saying through the more standard patient satisfaction surveys may have been due to a few factors Couch explains.

First, because the follow-up phone calls were being made during standard work hours, they may have been missing the group of patients were working. Second, patients may have been hesitant to bring up any negative experiences with a live person.

"We were looking for an avenue where patients felt more comfortable to discuss any issues as far as why they didn't not feel their ED experience was a good as it could have been," Couch says. "I think that's one of the things that appealed to us about the new system. I do think people will talk more and give more feedback and more information when they're texting and emailing versus one-on-one with another person."

If You're Happy (or Disappointed) and You Know it, Send a Text
The new NPMC follow-up call system automatically generates a text or email (based on patient preference) for every patient who was registered in the ED that day. The patient is asked to fill out a four-question survey by following a provided link.

Patients are asked:

• Do you have any questions about your discharge instructions including home care, medications and follow-up appointments?
• Please rate the nursing staff by the level of care and concern provided.
• Please rate the medical staff by the level of care and concern provided.
• Would you like to add anything else about your experience?

Couch or a nurse manager is automatically notified of the patient's response and can give the patient feedback within minutes of the survey's completion. It may sound like a great deal of work, but Couch says it is not time-consuming at all since many of NPMC's answers are "preset" in the system.
She can also adjust the responses based on trends in the responses. For example, if a patient says, "I'm still not feeling better. What do I do?" A preset response can be sent, directing the patient to follow-up with her primary care provider or return to the emergency department.

Though the program has only been in place for about six months, Couch says she is pleased with the results thus far. And while the response rate has not changed much yet, the surveys are reaching a much larger group of patients. Couch says the response rate does seem to be increase a bit each month and satisfaction scores are also on the rise.

"We've implemented a lot of new things up there, and yes, we have seen an increase in our satisfaction and our mean score is almost doubled over the almost six months" she says.

Couch hopes to see the program expand to the entire hospital.

"I think the way healthcare is and the generation that we're living in now, that people are going to be more apt to answer a text or an email than phone calls," she says. "The way we feel is that any feedback, whether it positive or negative, we can improve on all encounters."